Traumatic brain injury (TBI) remains a serious public health issue. It is the leading cause of both mortality and morbidity in the United States in 1-44 year old age group. Multitudes of pathophysiological injuries encompass traumatic brain injury. These include subdural and epidural hematomas, subarachnoid hemorrhage, contusions, global and regional cerebral edema, diffuse axonal injury, and vascular injury. Therapy is directed at preventing secondary brain damage by treating the evolving cascades of injury. Immediate and baseline supportive care is provided for all patients with moderate to severe head injury. Secondary brain injury may result from pre-hospital and in hospital hypoxemia and hypotension. Intracranial pressure (ICP) monitoring, with either a subarachnoid bolt or external ventricular drain (EVD), has become the standard of care for patients with severe head injury. Decompressive craniectomy (DC) involves removing a portion of the skull and allowing the edematous brain to swell outwards, thereby reducing intracranial pressure.